Malaria: The Iron and Folate Debate.

Marion Kelly summarised recent deliberations
among NGOnut contributors in relation to the administration of iron (and
folate) in malaria endemic areas. Below is her summary in point format.

Iron :

1. Iron should not be given IM if
the risk of malaria is high - too much iron in the blood stream encourages
malaria parasites and bacteria to grow.

2. Oral iron is safe for non infected
children - weekly doses are just as effective as daily doses.

3. Opinion is divided as to whether
oral iron should be given to children potentially infected with malaria
without also giving malaria treatment.

3b. Oral iron is safe to give along with
effective antimalarial treatment.

4. In cases where children are severely
malnourished (with or without malaria) - oral iron should only be given
AFTER the 'acute' stage (return of appetite/rapid weight gain).

Folate :

5. Evidence suggests that VERY high
doses of folate reduces effectiveness of Fansidar (sulphadoxine-pyrimethamine).
Early study results indicate that low folate doses may be used during Fansidar
treatment; other experts advocate delaying folate administration, in well-nourished
children, until one to two days into treatment.

6. Folate MUST BE given without delay
during treatment of severe malnutrition, and to all those with folate deficiency.

An international consultative committee
(INACG) will meet in Washington DC later this year to consider these issues
and try to arrive at a consensus.

Watch this space for the next update!
( Iron; also known as 'ferrous sulphate'
or 'fe')
( Folate; also known as 'folic acid')